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The risks of gastrointestinal adverse events with initiation of sodium polystyrene sulphonate

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Sodium polystyrene sulphonate (SPS) has been widely used for hyperkalemia management in chronic kidney disease (CKD). However, data on its safety are scarce and ambiguous. A retrospective cohort study based on the nationwide Swedish Renal Registry examined patterns of use and adverse events associated to SPS initiation during follow-up. 3690 patients initiated SPS during follow-up, of whom 59% took SPS chronically. SPS initiation was associated with a higher incidence of both severe (mainly attributed to ulcers and perforations) events, particularly in those receiving per label doses, and minor gastrointestinal events, regardless of dose.

Read the full article here: https://academic.oup.com/ndt/article/35/9/1518/5543535

 

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Are all donated kidneys the same?

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The increase in kidney transplant activity in Spain in recent years has relied on acceptance of organs from increasingly older donors and donation after circulatory death (cDCD). This has triggered Concerns about outcomes achieved with these elderly cDCD. A single-ceter retrospective study evaluated 87 cDCD-kidney transplant recepients (KTrs), 46 from donors ≥65 years of age and 41 from <65 years, and 126 brain death donors (DBD) KTrs from donors ≥65 years of age. Short and medium-term graft survival from elderly cDCD kidneys were excellent and comparable to those from young cDCD and elderly DBD kidneys. Donor characteristics exhibited no influence on 3-year recipient survival.

Read the full article here: https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfaa114/5903827

 

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Which phosphate transporters should be targeted to reduce hyperphosphatemia?

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NaPi-IIb, a type II sodium-dependent phosphate transporter, is considered a dominant transporter in rodents for phosphate absorption in the small intestine. However, the regulation of its expression in chronic kidney disease (CKD) is still ambiguous. A recent study measured protein expression level of NaPi-Iib in CKD-rats by mass spectrometry to evaluate the extent of phosphate transport via this molecule. The results showed that  the contribution of NaPi-IIb to intestinal phosphate absorption dramatically decreases in CKD, suggesting that in order to improve handling of hyperphosphatemia in CKD it is mandatory to inhibit other phosphate transporters as well.

Read the full article here: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaa156/5900877

 

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Does ADH modulate renal calcium excretion in patients with CDI and hypercalciuria?

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Antidiuertic hormone (ADH), commonly known for regulating body’s water balance, has recently been linked to osteoporosis during ageing and microgravity/bed rest. This prompted a research on the possible role od ADH in modulating renal calcium excretion. Data for 12 patients with central diabetes insipidus (CDI) and measured 24-h urinary excretion levels of calcium have been retrospectively analyzed before and after treatment with ADH analog. The patients had hypercalciuria even though their urine was diluted compared to normal controls. ADH analog reversed this effect, supporting the intruiging relationship between ADH and osteoporosis.

Read the full article here: https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfaa134/5906164

 

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Tolvaptan maintains diuretic action in hemodialysis patients

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Tolvaptan is an oral aquaretic agent which selectively antagonizes arginine vasopressin V2 receptors and increases free water excretion. A total of 124 hemodialyzed patients with preserved diuresis were recruited in a randomized, double-blind, placebo-controlled, Phase 2 trial to assess tolvaptan efficacy and safety. They were randomized to receive oral tolvaptan 15 mg/day or 30 mg/day, or placebo for 24 weeks. Tolvaptan treatment sustained diuretic action, but did not significantly reduce total fluid removal by hemodialysis or interdialytic weight gain. The drug was safe and well-tolerated during the study period.

Read the full article here: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaa148/5903094

 

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PR3-ANCAs predict relapses in ANCA-associated vasculitis patients after rituximab treatment

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Rituximab (RTX) is an effective remission-induction and maintenance treatment for patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The major challenge of patient care is the early detection of relapse to prevent organ damage and improve survival in these individuals. A recently published single-center cohort study assessed serial ANCA, CD19+ B-cell status and relapse rate in 110 ANCA-positive AAV patients treated with RTX. Overall, the absence of proteinase 3 (PR3)- or myeloperoxidase- ANCA positivity was highly predictive for remaining relapse-free. ANCA- and B-cell monitoring could guide therapeutic decision-making to prevent relapses in AAV patients treated with RTX.

Read the full article here: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaa066/5864952

 

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Acute PD in the treatment of COVID-19-related AKI

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Acute kidney injury (AKI) may occur in 4-23% of patients with COVID-19. Those who require renal replacement therapy have mainly been treated with extracorporeal dialysis. However, peritoneal dialysis (PD) may also be considered as a valuable treatment option in such cases when there is a capacity limit or availability constraint of equipment and supplies for extracorporeal dialysis techniques. Automated PD is the preferred option, but if not available, continuous ambulatory PD could also be used. The initial prescription should be 10 to 12 exchanges per day, tapered to 4 to 5 exchanges after 3 to 4 days, depending on the clinical evolution.

Read more about the practical aspects of prescribing, delivering and monitoring PD in COVID 19-related AKI here: https://academic.oup.com/ckj/article/13/3/269/5864956

 

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Easy estimation of renal growth rate in ADPKD

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Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the exponential and unlimited enlargement of the total kidney volume (TKV) associated with a decrease in renal function. In the prospective, placebo-controlled tolvaptan efficacy and safety in the management of ADPKD and its outcomes (TEMPO) 3:4 trial a mixed-model repeated-measures analysis was applied to assess a treatment benefit in reducing the TKV increase rate. The proposed equation for height-adjusted TKV increase via just one measurement would be clinically useful, but further studies are needed to validate it on larger number of patients with varying ethnicities and with long-term follow-up.

Read the full article here: https://www.kireports.org/article/S2468-0249(20)31358-9/fulltext

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Are those really SARS-CoV-2 virions in the kidney?

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Several studies report direct infection of different types of kidney cells by SARS-CoV-2 detected by transmission electron microscopy (TEM) both on post-mortem analysis and kidney biopsy specimens. However, these studies did not include detection of viral RNA or other methods for viral detection of kidney specimens and thus it is unclear whether the observed particles are definitely coronavirions or other similar coated vesicles eg clarthrin coated vesicles, which are comparablein size and morphology. Frelih et al used RT-PCR to identify direct invasion of SARS-Co-V2 in conjunction with TEM analysis on fresh post-mortem lung and kidney specimens of COVID-19 patients.

Read the full article here: https://www.kireports.org/article/S2468-0249(20)31368-1/fulltext

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Is longer dialysis necessarily better? The results of the ACTIVE Trial

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A Clinical Trial of IntensiVE (ACTIVE) Dialysis randomized 200 participants to extended hours (≥24 hours/week) or standard (≤18 hours/week) dialysis for 12 months to determine whether extended hours result in improved survival. After completing the 12-month study period participants could change their dialysis regimen, but continued a pre-specified observational follow-up for a further 4 years. Overall, participants were followed for a combined 877.5 patient-years. There was no improvement of long-term survival noted; suggesting that the optimal “amount” of dialysis across a broad range of dialysis recipients is yet to be defined.

Read the article at https://onlinelibrary.wiley.com/doi/abs/10.1111/nep.13737

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